How to Calculate the Total Value of My Disability Benefits Claim

March 21, 2024 | J. Price McNamara
How to Calculate the Total Value of My Disability Benefits Claim
How to Calculate the Total Value of My Disability Benefits Claim

If you have a disability and need to file a claim for benefits, you might be feeling stressed and confused. You might wonder how much money you can get and how to prove your disability. Don't worry, an experienced legal professional is here to help. Read on about how to estimate the value of your claim and why you should always talk to an ERISA insurance claim lawyer.

Know Your Plan

Know Your Plan

The foundation of your claim begins with a thorough understanding of your disability insurance policy. This document is your roadmap to understanding your eligible benefits and under what conditions.

  • Benefits Period: This is the timeframe that you can receive payments. Some policies offer benefits for several years, while others may provide support until retirement age.
  • Benefit Amount: Typically expressed as a percentage of your salary, this figure is what the insurer agrees to pay you monthly should you become disabled.

Reviewing your policy closely with the assistance of an ERISA attorney can clarify these points and more, setting the stage for a well-informed claim process.

Calculate Your Monthly Benefits

How much you'll receive each month involves basic math based on your salary and the coverage percentage defined in your plan.

Determining Your Average Monthly Earnings

When preparing to file a disability benefits claim, one of the first steps is to accurately determine your average monthly earnings.

Average monthly earnings typically include your base salary, but they can also include other forms of compensation depending on the specifics of your disability insurance policy. For many, this can include overtime pay, bonuses, commissions, and other incentives that contribute to your total compensation. Your average earnings directly influences the benefit amount you're eligible for.

It's important to gather and review your pay stubs, tax returns, and other financial documents that reflect your earnings over a significant period before your disability. The aim is to establish a comprehensive and accurate picture of your financial earnings.

This step may require time and effort, particularly if your monthly income varies. For those with fluctuating incomes, insurers often calculate an average based on your earnings over the last year or the period stipulated in your policy, ensuring a fair representation of your typical income.

Applying the Coverage Percentage

Once you've established your average monthly earnings, the next step is to apply the coverage percentage defined in your disability insurance policy. This percentage determines the portion of your earnings the insurance will replace in case of a disability.

Coverage percentages vary by policy, but a common figure is around 60 percent of your average monthly earnings. This means if your policy stipulates a 60 percent coverage rate and your average monthly earnings are $3,000, your disability benefit will be calculated at $1,800 per month.

This calculation helps in budgeting and financial planning and evaluating whether you need to seek additional coverage or sources of income to meet your needs while you cannot work. It's a simple mathematical operation, but it has significant implications for your financial well-being. Ensure you've spoken to an ERISA lawyer to correctly determine this figure, as errors or misunderstandings here can lead to surprises down the road.

This calculation will give you a ballpark figure of what to expect, helping you plan your budget when you cannot work.

Consider the Duration of Benefits

Consider the Duration of Benefits

The length of time you can receive benefits is a pivotal factor in understanding the total value of your claim.

There are two primary types of disability benefits:

Short-Term Benefits

Short-term disability benefits serve as a financial bridge for individuals facing temporary disabilities that hinder their ability to work. Designed to provide support during the initial period following an injury or illness, these benefits typically cover a span lasting from a few months to two years. The aim is to offer a semblance of financial stability when an individual cannot earn their usual income due to a medical condition.

The process for claiming short-term benefits usually involves a waiting period, often called an elimination period, which represents the time between the onset of disability and when benefits start. Depending on the policy specifics, this period can vary from a few days to several weeks.

The benefits kick in once the elimination period has passed, providing the individual with a portion of their pre-disability income. This financial support is essential for covering everyday living expenses and medical bills, helping to alleviate the stress associated with lost income.

Short-term disability benefits are particularly important for those who do not have substantial savings to fall back on or who live paycheck to paycheck. By offering a percentage of the individual's salary, these benefits ensure that people can continue to meet their financial obligations without depleting their savings entirely.

However, the duration of these benefits is limited, encouraging people to return to work as soon as they are medically able. The transition back to work is often supported by the policy through rehabilitation services or a gradual return-to-work program, ensuring that the individual does not rush back and risk further health complications.

Long-Term Benefits

Long-term disability benefits cater to those facing more severe and prolonged health conditions that extend beyond the coverage period of short-term benefits. These benefits can last several years, often until the beneficiary reaches retirement age, providing a much-needed financial safety net for those who cannot return to work due to their condition.

The eligibility for long-term benefits usually requires a more rigorous evaluation process than short-term benefits, given the extended duration and higher financial commitment involved. Insurers often require comprehensive medical evidence to support the claim of long-term disability, including detailed medical records, diagnostic tests, and sometimes independent medical examinations. This rigorous process ensures that only those who cannot work due to disability receive long-term benefits.

Once approved, long-term disability benefits offer a portion of your pre-disability income, aiding in managing household expenses, ongoing medical treatments, and financial security. The exact percentage of income replaced varies by policy but aims to balance providing the necessary support and incentivizing a return to work if your condition improves.

Factor in Cost-of-Living Adjustments (COLAs)

COLAs are an important feature of some disability insurance policies, designed to ensure your benefits keep pace with inflation.

  • Annual Adjustments: Many COLAs adjust their benefit amount annually based on a predetermined formula or index, such as the Consumer Price Index (CPI).
  • Long-Term Impact: Over time, these adjustments can significantly increase the total value of your benefits, especially for long-term disability claims.

Including COLAs in your calculations can provide a more accurate estimate of your claim's value over time, offering better financial security.

Account for Other Benefits

Disability insurance policies often include provisions for additional benefits, which can increase the total value of your claim.

Lump-Sum Payments

disability Benefits

Within the realm of disability insurance, lump-sum payments stand out as a significant provision that can substantially increase the overall value of a claim. These are one-time payments made to the insured under specific conditions or circumstances outlined within the policy. Unlike regular monthly benefits that provide ongoing support, lump-sum payments are designed to offer an immediate financial boost, often at times when it is most needed.

Lump-sum payments are typically associated with certain diagnoses or events that profoundly impact the insured's life. For example, a policy might include a provision for a lump-sum payment if the insured is diagnosed with a critical illness, such as cancer, heart attack, or stroke, recognizing the immediate and significant financial strain these conditions can impose. This financial assistance can allow people to cover high medical bills, make necessary home modifications, or settle other urgent expenses without the need to dip into savings or incur debt.

The criteria for receiving a lump-sum payment, the amount awarded, and the conditions covered vary widely between policies. It's wise for policyholders to understand these details, ensuring you can fully leverage this benefit if you ever meet the qualifying criteria. This knowledge empowers you to plan more effectively for the future, understanding the comprehensive support your policy provides beyond monthly income replacement.

Partial Disability Benefits

Partial disability benefits address the needs of individuals who, due to their disability, can still work but not in their full capacity or previous role. This scenario is common for many facing long-term health issues, where the progression back to full-time employment is gradual or, in some cases, impossible. Partial disability benefits are structured to compensate for the difference in earnings, providing financial support that bridges the gap between pre-disability income and current earning capacity.

The concept behind partial disability benefits is to encourage and support the insured's return to the workforce in whatever capacity they can, without fearing immediate financial loss. This approach not only aids in psychological and physical recovery by promoting activity and engagement but also ensures a smoother financial transition for the individual and their family. The benefits are calculated based on a formula that considers the disparity between the insured's earnings before and after the onset of disability, aiming to supplement the reduced income in a fair and balanced manner.

Both lump-sum and partial disability benefits significantly enhance the utility and value of disability insurance policies. They reflect the industry's understanding that disabilities affect people in many ways, requiring various solutions to meet their financial needs.

The Importance of Having an ERISA Attorney

While the above steps offer a basic framework for estimating the value of your disability benefits claim, the process is often more complicated. That's where an ERISA lawyer comes in:

Understanding Complex Regulations with an ERISA Lawyer

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to protect individuals in these plans. ERISA's regulations surrounding disability claims are intricate and challenging for many to understand without specialized knowledge.

An ERISA lawyer can help identify critical aspects of your claim governed by ERISA, ensuring that your application or appeal complies with all necessary legal requirements. An ERISA lawyer can aid you so you avoid common pitfalls that can delay or jeopardize your claim.

Maximizing Your Claim

An ERISA lawyer can ensure you fully utilize the benefits available under your plan. An ERISA lawyer can review your policy's provisions in detail to uncover all potential benefits you may be entitled to. This includes identifying any overlooked aspects of your claim that can increase its value, such as unclaimed benefits or entitlements you may not have considered.

By advocating on your behalf, an ERISA lawyer ensures that your claim is presented in the most favorable light, maximizing its overall value.

Handling Appeals

Facing a denial of your disability benefits claim can be disheartening, but it is not the end of the road. An ERISA lawyer will guide you through preparing and submitting your appeal, ensuring that it effectively addresses the reasons for the initial denial. This often involves gathering additional medical evidence

and securing professional testimony to strengthen your case. An ERISA lawyer understands the importance of a well-structured appeal that meets all procedural and substantive requirements, significantly improving the chances of overturning the denial.

Negotiating Settlements

In certain situations, settling might be the most advantageous outcome for your disability claim. This process requires skilled negotiation to ensure that the settlement is fair and adequately compensates for the benefits you are claiming.

An ERISA lawyer has the experience and negotiation skills to represent your interests effectively during settlement discussions. An attorney can evaluate any settlement offers critically, advise you on the merits of accepting or rejecting an offer, and work to negotiate better terms if necessary. The goal is always to achieve a settlement that reflects the true value of your claim and provides you with the financial support you need.

J. Price McNamara, ERISA Insurance Claim Attorney
J. Price McNamara, ERISA Insurance Claim Lawyer

Reach Out to an ERISA Attorney Today

Calculating the total value of your disability benefits claim is a step in securing your financial future if you cannot work due to a disability. While you can start this process independently, the complexities of disability insurance and ERISA regulations make consulting with an experienced ERISA lawyer highly advisable. A lawyer can ensure you receive the full benefits you're entitled to.

J. Price McNamara Author Image

J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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